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The Polity ThinkShop brings you this important report on the State of our American State

Have unions been dealt yet another blow, now ironically by the well intentioned ACA reform?

If the federal government mandates that business and individuals obtain insurance is this setting a president for the federal government to regulate and mandate worker gains without the use of union muscle?

These are provocative questions, at least for people who still remember the sacrifices that were made to create unions and the horrible conditions that preceded them.

“Last week’s vote by workers at Volkswagen’s Chattanooga, Tenn. plant against joining the United Auto Workers union — despite VW’s tacit encouragement — points up the challenges faced by U.S. organized labor. Even though unions retain much public support, the share of American workers who actually belong to one has been falling for decades and is at its lowest level since the Great Depression.

In a Pew Research Center survey conducted in June 2013, about half (51%) of Americans said they had favorable opinions of labor unions, versus 42% who said they had unfavorable opinions about them. That was the highest favorability rating since 2007, though still below the 63% who said they were favorably disposed toward unions in 2001. In a separate 2012 survey, 64% of Americans agreed that unions were necessary to protect working people (though 57% also agreed that unions had “too much power”).”

The Kaiser Family Foundation policy research on medicaid expansion and the implementation of the current healthcare reform is very optimistic and useful. However, it would be prudent to look at the local healthcare infrastructure’s ability to both create (healthcare outreach) and meet the new demand for the coverage that the healthcare act promises. Indeed, a decade of the most draconian recession in recent history has not helped the public health sector to recruit and diversify its workforce in order to be ready to take on the potential numbers of Latinos, for example, who would benefit disproportionately from the new access as they are over represented in the labor and business sectors that currently provide jobs without health benefits. According to the Kaiser Family Foundation, the healthcare reform picture is quite rosy, but for Latinos healthcare reform may not be quite the rose garden envisioned by current mainstream health policy pundits. The Policy ThinkShop

According to the Kaiser Foundation:

“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in evaluating the ACA Medicaid expansion are:

1. What are the fiscal implications of the ACA Medicaid expansion for states?

Overall, many states are likely to see net savings from the Medicaid expansion.

The Medicaid expansion also may have positive economic effects for states like increased jobs, revenues or economic activity.

Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.

Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program. Congress has only amended the formula to provide more federal funding, not less.

2. What effect will the Medicaid expansion have on coverage?

The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.

A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people. Despite claims to the contrary, research points to improved outcomes and reduced mortality from Medicaid coverage.

Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion.

For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.

3. What flexibilities do states have in implementing the Medicaid expansion?

States have considerable flexibility to administer traditional Medicaid programs.

Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.

Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.

States also continue to have ability to seek approval for demonstration waivers. Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.”

After years of the seemingly inadvertent fomentation of distrust among its polity (the growing role of the U.S. government and the Vietnam war, for example), technology has opened up a potentially ubiquitous eavesdropping by the federal government that is eerily reminiscent of George Orwell’s 1984. It does not seem sinister, though, since it thus far appears to be the outcome of an aggressive privatization policy that was probably compelled by the rapid implementation of our most recent wars. Nevertheless, Americans have the right to ask question, remain vigilant and demand answers if not reform.

“A majority of Americans – 56% – say that federal courts fail to provide adequate limits on the telephone and internet data the government is collecting as part of its anti-terrorism efforts. An even larger percentage (70%) believes that the government uses this data for purposes other than investigating terrorism.

And despite the insistence by the president and other senior officials that only “metadata,” such as phone numbers and email addresses, is being collected, 63% think the government is also gathering information about the content of communications – with 27% believing the government has listened to or read their phone calls and emails.”

Mass information gathering by for profit companies and the use of that information is becoming a major issue for societies, groups and individuals who are gradually waking up to the reality that if you type it with a keyboard or upload it and hit the send key you might as well be writing graffiti on government building walls and leaving your name and address in the bottom right hand corner.

What is amazing is how innocent and lulled most of us have been about the use of computers and keyboards. Especially allowing kids to spend hours unsupervised on the same machines we do our most important communicating with banks, friends, colleagues, you name it.

So here we are having a debate about our relationship with online entities and the use of the data we willingly share and that data they are also able to produce deductively beyond what we are willing to share.

Whether we have anything to hide or not, most of us assume we get to make that choice.

Apparently, our keyboards, desktop computers and online connection are a gateway to big business and big brother which today seem to be becoming one and the same.

“LET’S get the most contentious point out of the way first: Edward Snowden made the right call to make public the extent of the National Security Administration’s surveillance of electronic communications. The American people can now have a debate about whether or not they consent to that level of surveillance in order to prevent terrorist attacks, a debate that we were previously denied by the government’s unwillingness to disclose even the …”

The Patient Protection and Affordable Care Act promises to change our healthcare system once and for all to solve many of its ongoing malformations and contradictions … No where is this more true than in its expansion of healthcare services to persons under the Medicaid umbrella. The Kaiser Foundation web, which always provides data and balanced analysis on the usually controversial health issue and so called “entitlement programs” like Medicaid. The link below includes an entire report showing estimated impact on each of the 50 states …

“A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population.

This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.”

The full-time National Health Service Corps Loan Repayment Program offers up to $60,000 in tax-free loan repayment for 2 years of service, and up to $140,000 for a total of 5 years of service.

National Health Service Corps scholars commit to serve in the Corps upon completion of their training — 1 year for each year of support (at least 2 years).

The Students to Service Loan Repayment Program provides loan repayment assistance of up to $120,000 to medical students (MD and DO) in their last year of school, in return for a commitment to provide primary health care services in eligible Health Professional Shortage Areas of greatest need for at least 3 years.

The State Loan Repayment Program provides grants to states to operate their own loan repayment programs. Similar to the NHSC Loan Repayment Program, participants in the state programs provide primary health services in Health Professional Shortage Areas in exchange for repayment of their qualifying educational loans. States are required to match federal grant funds dollar-for-dollar with non-federal funds.

According to self-reports by the nearly 10,000 Corps clinicians currently providing care – 13 percent are African American, 10 percent are Hispanic, 7 percent are Asian or Pacific Islander, and 2 percent are American Indian or Alaska Native.

In FY 2012, African American physicians represent 17 percent of the Corps physicians which exceeds their 6.3 percent representation within the national physician workforce. And,

Hispanic physicians represent 16 percent of the Corps physicians, exceeding their 5.5 percent representation in the national physician workforce.

According to self-reports more than half of by the nearly 1,000 Corps scholars in the pipeline are minorities – 26 percent are Hispanic, 19 percent are African American, 12 percent are Asian or Pacific Islander, and 2 percent are American Indian or Alaska Native.

President Obama made a surprise trip here on Tuesday to sign a landmark strategic partnership agreement between the United States and Afghanistan in a midnight ceremony meant to mark the beginning of the end of a war that has lasted for …

Increasingly, philanthropists and philanthropic institutions are becoming more strategic in their efforts, working to leverage their assets – money, knowledge and networks – to achieve greater results. The Center studies the structures and networks that enable philanthropy to work better together to extend its impact as a field, and the alliances that enable philanthropic organizations and individuals to work with partners in nonprofits, government and business to solve public problems. The Center’s Distinguished Speakers Series also provides a venue for nationally recognized leaders to stimulate a conversation on the role that philanthropy can and should play in public problem solving.

The steep, two-year decline in employment triggered by the Great Recession was followed by slow but steady gains in employment for all groups of workers. However, the rapidly changing demographics of the American workforce has meant that the gains in jobs have varied across different groups.

Hispanics and Asians experienced a faster rate of growth in jobs than other groups. Their employment levels are higher now than just before the start of the recession in December 2007, a milestone not yet reached by white and black workers.

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House Budget Committee Chairman Paul Ryan’s new budget plan specifies a long-term spending path under which, by 2050, most of the federal government aside from Social Security, health care, and defense would cease to exist, according to figures in a Congressional Budget Office analysis released …

In general, more Americans say that government regulation of business is harmful than say it is necessary to protect the public. At the same time, when asked about regulating specific areas, such as food safety and environmental protection, there is broad support for strengthening or maintaining current regulations.

Just over half (52%) of people say government regulation of business usually does more harm than good, while 40% think regulating business is necessary to protect the public interest. These results, from a survey conducted Feb. 8-12, are similar to those from January 2008, before the financial crisis and onset of the economic recession.

In seemingly endless times of “trash talk” that led to an improbable and unpopular political victory, the newly minted president clamors: “Now arrives the hour of action.” Fleeting relief comes to the nation as the transition […]

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